S989 Outcomes of Patients Admitted With Acute, Severe Ulcerative Colitis on Established Biologic Therapy: A Retrospective Analysis from a Tertiary Referral Hospital

Introduction: Acute, severe, ulcerative colitis (ASUC) is a phenotype of UC that is associated with significant morbidity. In steroid refractory ASUC, salvage medical therapy with infliximab is recommended to reduce the risk of colectomy. However, the evidence supporting this practice is based on cohorts naïve to biologics. Consequently, the management of patients on established biologic or small molecule therapy (EBST) with ASUC is not well defined. Methods: We conducted a retrospective chart review of patients admitted with ASUC to Mount Sinai Hospital (MSH) in Toronto, Ontario from January 2018 until January 2022. Included subjects were considered to be on EBST if they had received a dose of these agents within 56 days prior to admission. Our primary outcome was the mean difference in hospital length of stay (HLOS) between the 2 groups. Additional outcomes of interest include rates of surgical consultation, rates of inpatient colectomies, and 90-day readmission rates. Results: Of the 185 admission for ASUC, 76 were on EBST and 109 were not. Baseline characteristics were similar between the 2 groups. There were no significant differences in hospital length of stay (7.46 days vs 7.45 days p = 0.52) or in-hospital colectomy rates between the 2 groups. Patients on EBST had higher rates of surgical consultation (36.8% vs 8.3% P< 0.01) prior to discharge and 90-day readmission rates (26.3% vs 13.8% p = 0.03). Conclusion: Patients on EBST were more likely to receive a surgical consultation during their admission and had higher rates of readmission at 90 days. ASUC remains a challenging clinical entity to manage and further studies evaluating the underlying factors that contribute to readmission in patients on EBST in hospital are needed (Figure 1, Table 1).Figure 1.: Comparison of duration of intravenous steroids and hospital length of stay in patients on EBST vs not on EBST. Table 1. - Baseline characteristics and admission severity Not established (N=109) Established (N= 76) P value Patient characteristics Age (years) 34.9 (SD 11.8) 31.5 (SD 11.6) 0.05 Males 43 (39.5%) 41 (54.0%) 0.07 Current tobacco use 5 (4.6%) 3 (4.0%) 1.0 Current alcohol use 38 (34.9%) 25 (32.9%) 0.90 Disease duration (years) 6.2 (SD 7.4) 5.4 (SD 5.3) 0.43 UC flare requiring admission within 1 year 20 (18.4%) 35 (46.1%) < 0.01 Baseline medication use 5-ASA use 63 (57.8 %) 19 (25.0%) < 0.01 Immunomodulator use (AZA/MTX) 4 (3.7%) 16 (21.0%) < 0.01 Previous anti-TNF therapy 13 (11.9%) 28 (36.8%) < 0.01 Previous Vedolizumab therapy 3 (2.8%) 13 (17.1%) < 0.01 Previous Ustekinumab therapy 0 (0%) 1 (1.3%) 0.90 Previous Tofacitinib therapy 0 (0%) 0 (0%) N/A Exposure to ≥ 2 biologics 4 (3.7%) 29 (38.2%) < 0.01 Admission severity Bowel movements ≥ 10 per day 75 (70.7%) 66 (86.8%) 0.02 Systolic blood pressure ≤ 100 mmHg 37 (33.9%) 22 (28.9%) 0.58 Heart rate ≥ 100 bpm 64 (58.7%) 39 (51.3%) 0.40 Temperature ≥ 38.0 Celsius 24 (22.0%) 15 (19.7%) 0.85 CRP (mg/L) 67.4 (SD 62.4) 41.8 (SD 50.1) < 0.01 Hemoglobin (g/L) 118.2 (SD 23.5) 113.3 (SD 22.6) 0.16 White blood cell count (109/L) 11.6 (SD 3.9) 10.9 (SD 5.2) 0.32 Current biologic in patients on established biologic therapy (N=76) Infliximab 36 (47.4%) Golimumab 5 (6.6%) Adalimumab 8 (10.5 %) Vedolizumab 20 (26.3%) Ustekinumab 6 (7.9%) Tofacitinib 1 (1.3%)

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